Child s Awesome Adventure Camp Summer 2018 Flex Pass Registration Flex Pass Daily Registration Fees Before Camp Summer Camp After Camp $7R / $10NR $39R / $45NR $9R / $12NR Address: City: FOR OFFICE USE ONLY Parent s Amount Paid Staff Initials Flex Pass Policies T-Shirt Provided (for Field Trip Registrations Only) All Flex Pass registrants must have Awesome Adventure Camp emergency & permission forms on file & full payment is due at the time of registration. Registrations made at least two days in advance will qualify for regular rates. Refunds will not be provided within two days of the program date. Registrations within two days may be accepted but a $5 Late Registration Fee will be automatically incurred for each program. A limited number of Flex Passes are available each day & registration may be closed out at any point please register as far in advance as possible. Please check the boxes of each program you would like to register for: 1 2 Before Camp Monday Tuesday Wednesday Thursday Friday Summer After Before Summer After Before Summer After Before Summer After Before Summer Camp Camp Camp Camp Camp Camp Camp Camp Camp Camp Camp Camp Camp 5/28 5/29 5/30 5/31 6/1 6/4 6/5 6/6 6/7 6/8 After Camp 3 4 5 6 7 8 9 10 11 12 6/11 6/12 6/13 6/14 6/15 6/18 6/19 6/20 6/21 6/22 6/25 6/26 6/27 6/28 6/29 7/2 7/3 7/4 7/5 7/6 7/9 7/10 7/11 7/12 7/13 7/16 7/17 7/18 7/19 7/20 7/23 7/24 7/25 7/26 7/27 7/30 7/31 8/1 8/2 8/3 8/6 8/7 8/8 8/9 8/10 8/13 8/14 8/15 8/16 8/17 Please review and sign the reverse side of this form.
I will review with my child and I agree to abide by all policies listed in the Awesome Adventure Camp handbook. Parent/Guardian Signature: Date:
Child s Name (one participant per form): Awesome Adventure Camp 2018 Emergency Information Address: City: Zip: Birth Date: Age: Sex: M F Entering Grade (circle one): K 1 2 3 4 5 6 School: Mother/Guardian s Cell Phone Number: Father/Guardian s Cell Phone Number: Email: Work Phone Number: Email: Work Phone Number: Do both parents have custody: Yes No If not, who is the custodial parent/guardian? Please provide information below that will help us to create a safe and healthy environment for your child. Lack of detailed information compromises our staff s ability to successfully accommodate your child. The Carol Stream Park District is not responsible for any injuries, complications, damages or losses due to lack of provided information. Many resources and adaptations are available to assist your child in having a successful summer. Are your child s immunizations up-to-date? Yes No When was your child s last tetanus shot? Allergies/Dietary Restrictions: Medical Concerns/Medications: If your child has medication that may need to be administered by CSPD staff or medication that may be selfadministered (including asthma inhalers), a Permission to Dispense Medication Form must be completed. Is there anything else we should know about your child (fears, concerns, behavior issues, etc.) in order to provide a successful camp experience? Does your child have any special needs or need one-on-one assistance? Yes No If yes, please give details and note that one-on-one aides must be requested at least two weeks in advance: Please complete the reverse side of this form.
Awesome Adventure Camp 2018 Authorized Contact & Release Form Child s Date: Parents/Guardians listed on the front with custody have authorization to pick up the participant. Please list siblings, parents without custody, relatives, or friends who are also authorized to pick-up your child. All individuals must present a picture I.D. in order for your child to be released into their custody. Only the custodial parent(s) may approve additions and/or changes to the Authorized Pick-up List. For emergency purposes, one authorized contact person must live within a five mile radius of Carol Stream. Authorized Pick-up List: Please list anyone who is NOT authorized to pick up your child: If unable to contact a parent/guardian and if necessary, we will call emergency services (911) and your child will be transported to the nearest hospital at the parent/guardian s expense. Please see the parent handbook for additional medical procedure information. Primary Physician: Primary Hospital: Physician Phone: Hospital Phone: I authorize the Carol Stream Park District to release my child to the above listed persons in the event that I am unable to pick up my child myself. I release the Carol Stream Park District from any and all responsibility once my child has been released into the custody of these above individuals. Parent/Guardian Signature:
Awesome Adventure Camp 2018 Permission Form Child s Date: Swim Permission In order to help us ensure your child s safety and proper supervision while attending Coral Cove Water Park, or another water park as a field trip, please complete the following information. Children listed as Swimmer or Unsure will be swim tested. Based on the results, campers who are unable to swim 25 yards unassisted will be restricted to certain areas of the pool. Non-Swimmer: My child is only approved to swim in the shallow end of any pool up to a maximum depth of 4 feet as well as water playgrounds, splash pads, sand areas, and tube water slides. Swimmer: My child can swim 25 yards unassisted. They are permitted to go into all pool areas up to a maximum depth of 12 feet, as well as water playgrounds, splash pads, sand areas, tube & drop water slides, and diving boards. (Campers will be swim tested to confirm.) Unsure: I am unsure if my child is a Swimmer or Non-Swimmer. Please swim test. They are permitted to go into all areas listed for Swimmers based on swim test results. Other Notes: Additional Field Trip Information Please help us to classify which group your child should be in when attending water park field trips. Mild Thrills: Child enjoys shallow pool areas, water playgrounds, splash pads, lazy rivers, & sand areas. Moderate Thrills: Child enjoys deep water, diving boards, tube water slides & the above attractions. Maximum Thrills: Child enjoys all attractions at water parks (funnel slides, drop slides, wave pools, & the above attractions). Some field trip attractions limit children based on their height. Child s Height: feet inches PG Movie Permission As a part of the Awesome Adventure Camp mission, our goal is to provide a safe place for your child to have an active, rewarding summer filled with memories that will last a lifetime. While the majority of our activities will take place outside, on occasion, participants may watch a movie or go to the movie theatre. Movies will only be shown during inclement weather, as a break from the summer heat, or as a relevant part of an activity. Movies will be restricted for your child based on your permission below. Yes, I give permission for my child to watch G or PG movies in the cases indicated above. If interested, please see a camp counselor regarding specific movies that may be shown. Indicate any PG movies that you will not permit your child to watch: No, I do not give permission for my child to watch PG movies. My child is not permitted to watch any movies during camp. Parent/Guardian Signature: